Why do best practices needed for parathyroidectomy in the treatment of primary hyperparathyroidism?

Updated: Dec 24, 2020
  • Author: Lawrence T Kim, MD, FACS, FACE; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Greene et al examined trends in surgeons' use of bilateral versus limited exploration for parathyroidectomy between 1998 and 2008. [36] Surveying 256 surgeons (members of the American Association of Endocrine Surgeons and the American College of Surgeons), who together accounted for 46% of parathyroid operations in the United States, the investigators found that in 2008, 10% of surgeons employed bilateral neck exploration, 68% used limited exploration, and 22% used both of these exploration techniques in their practice. In 1998, the statistics for surgeons using bilateral, limited, or both types of exploration were 74%, 11%, and 15%, respectively. The study indicated that the physicians who are most likely to use limited exploration are endocrine surgeons, surgeons with a high-volume practice, and surgeons whose mentors used limited exploration.

The authors also found that in 2008, half of the general surgeons surveyed never monitored parathyroid hormone intraoperatively (whether using bilateral or limited exploration), while the same held true for less than 10% of the endocrine surgeons. In addition, there was great variation "among subsets of surgeons in operative volumes, indications for bilateral neck exploration, [follow-up] care, expertise with [ultrasonography] and sestamibi, and perceptions of cure and complication rates." Greene and his coauthors concluded that because of the many differences that exist in the surgical management of hyperparathyroidism, best-practice guidelines may need to be defined.

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